We have instituted routine dynamic Intensity Modulated Radiation Therapy (dIMRT). This is the most complex of IMRT treatments and requires considerable pre-treatment verification to ensure accurate execution. These treatments are delivered using our twin Clinac-21EX accelerators. A Hi-ART system (Tomotherapy Inc.) for delivering treatments via helical tomotherapy has been installed, accepted and is currently treating patients. This system provides ROB with cutting edge treatment technology to support future clinical trials. We have started a series of initiatives with our Nucletron High Dose-Rate Afterloader (HDR) , using a small, high intensity 192Ir source for interstitial and intercavitary brachytherapy. Our radiosurgery capability has been expanded with the acquisition of 3 new applicators with diameters of 5mm, 7.5mm and 10mm. A new Philips Brilliance 16 slice, large bore CT Simulator has received couch control upgrades. On-board imaging (OBI) has been installed on the newer Clinac-21EX. The final component of the Varian RPM Respiratory Gating system for providing gated radiation therapy has been acquired and we are awaiting delivery. Respiratory gating will improve targeting ability by compensating for regular respiratory motions during treatment. The Radionics SRS head frame system has been adapted to the Tomotherapy unit using a special support fabricated in-house. Procedures have been developed for patient simulation and treatment planning with this system. On-board imaging has been added to the newest Varian accelerator. This provides diagnostic quality images, which makes anatomical and fiducial matching much more accurate. This is especially useful for prostate patients. A new treatment delivery system called RapidArc has been purchased for the newer Clinac-21EX and is scheduled for installation in late September 2010. This will provide some degree of redundancy with the Tomotherapy Hi-ART unit as well as offering some unique features. Treatment planning systems will also be upgraded with the new adaptive planning software. Modifications to the Tomotherapy treatment room have been implemented to improve the Quality Assurance process for HDR, as well as provide both an additional CCTV camera at the far end of the bore and a new noise cancelling intercom system for the Hi-ART unit to facilitate patient observation and communication in a high noise environment.